Santa Clara County has not had an acute-care, inpatient psychiatric unit for youth for more than 20 years, but the Board of Supervisors voted unanimously on Tuesday, June 9, to support a feasibility study for an inpatient unit for children and adolescents.
Youth with psychiatric issues are typically hospitalized locally for 72 hours on a "5150" psychiatric hold. But children under the age of 18 in need of longer-term inpatient treatment are sent to hospitals in Fremont, Vallejo, Concord and Sacramento, said Supervisor Joe Simitian, who introduced the action.
The locations put mentally fragile young people far from their families and place a hardship on parents and families, he said.
The need is great across all economic and demographic groups, Simitian said. In an eight-month period, hospital staff made more than 600 referrals for psychiatric beds out of the area. Of those, more than 400 were unduplicated referrals of Santa Clara County children and teens, according to county records, Simitian said.
But those figures are only for youth who are uninsured or on MediCal, he said.
"This doesn't include private pay or those with commercial insurance. I can't even speculate what that number would be," Simitian said.
The lack of beds for youth represents a significant problem, Simitian said.
"It's better therapeutically for kids to be close to their community, and their own local mental health providers, when they're in crisis," he said. "... I'm worried that having treatment options so far away deters kids and families from seeking the help they need.
"We know that these beds are an integral and essential part of the continuum of care. The next step is to figure out how to get the best possible help for these kids closer to home."
Santa Clara County is one of the largest urban counties in the state, yet there are more than 20 kids on any given day who are sent out of the county to seek treatment, he said.
Sarah Gentile, a Los Altos parent, said she has two children with medical needs. Her daughter has a serious and rare neuromuscular disease and her son has suffered from depression.
Doctors like rarity, she said, so her daughter has been seen by numerous heads of medical departments at local facilities. But when her son had a major depressive episode and needed to be hospitalized while undergoing a new medical treatment, Gentile got a rude awakening.
At the El Camino Hospital emergency room, the psychiatrist had to call around to see which facility could take her son, she said. Gentile, who initially did not understand the situation, wanted her son sent to Stanford, but then she learned that there were no beds in the county at all.
"I can't imagine leaving my child alone," she said, tearfully. "Even after a $2 billion expansion at Stanford, there are zero beds for kids."
Administrative staff will develop a report within six months, which will explore possible ways to create and fund the inpatient unit, including using existing county facilities, contracting out services, and having a flexible unit that could accommodate adults during low-peak times.
An inpatient unit would create a broader acute-care system for youth in the county, said Toni Tullys, director of the county's Behavioral Health Services Administration.
Supervisor Ken Yeager asked staff to look into potential collaborations with insurance companies and private health plans for how services would be covered.
Simitian and Yeager said the report should consider the demographic profile of youth needing the inpatient services, including their ages, ethnicity and geographical location.
Simitian also advised staff to not forget about insured or private-pay patients in addition to those without insurance or on MediCal, he added.
"Each one of those is a kid (in need)," he said.